Background: A cluster randomized controlled
trial with residents with stroke in care homes
(OTCH) aims to evaluate the impact of a complex
occupational therapy intervention focused on promoting
independence via activities of daily living. A
process evaluation is running alongside the OTCH
trial to examine intervention fidelity.

Method: An explanatory programme theory of
intervention fidelity which integrates aspects of
implementation and anticipated impacts has been
constructed to underpin the process evaluation.
The theory is being tested drawing on both indepth
semi-structured interviews (n = 17) and
reports of critical incidents from the trial (n = 20)
with all occupational therapists.

Results/findings: A key theme emerging from the
process evaluation relates to how occupational
therapists have had to balance the requirements of
delivering the OTCH trial intervention within both
care home and research contexts simultaneously.
Occupational therapists’ previous experiences,
characteristics of patients allocated to the trial and
the managerial structure of the care homes were
the factors that influenced how successful occupational
therapists were in achieving this balance.

Discussion: Occupational therapists with previous
research experience were more cognisant of
the study outcome measures, and used them to
guide patients’ goal setting. Occupational therapists
with extensive professional (non-research)
experience reported more confidence in their ability
to tailor more peripheral components of the
intervention, or to target goals outside the scope
of the trial intervention.

Conclusion: This process evaluation illuminates
the complexities in considering the fidelity of rehabilitation
trial interventions, specifically in how therapist
experience may influence implementation.